Daily Health Policy Report

Thursday, February 28, 2013

Last updated: Thu, Feb 28

KHN Original Reporting & Guest Opinion

Health Spending And Fiscal Battles

Health Reform


Capitol Hill Watch

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Some States Will Rate Health Plans On Quality This Fall

Kaiser Health News staff writer Julie Appleby reports: "This fall, health insurers in a few states will be seeing stars. Not the celestial kind, but stars that reflect their scores on quality measures designed to help consumers make better-informed decisions about what coverage to buy" (Appleby, 2/28). Read the story.

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FAQ On Medicare Doctor Pay: Why Is It So Hard To Fix?

Kaiser Health News staff writer Mary Agnes Carey reports: "While physicians have sidestepped drastic Medicare payment cuts for 2013, doctors’ groups and lawmakers are gearing up for yet another battle to scrap the formula that forces Congress to consider the 'doc fix' on a yearly basis. For doctors, the nail-biter has become a familiar but frustrating rite. Lawmakers invariably defer the cuts prescribed by a 1997 reimbursement formula, which everyone agrees is broken beyond repair. But the deferrals are always temporary due to the difficulty of finding offsetting cuts to pay for a permanent fix" (Carey, updated 2/27). Read the story.

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Capsules: Messaging Your Doctor? There’s An App For That; Tenet Shows Hospitals Will Cut Prices For Exchange Patients — But Only So Much

Now on Kaiser Health News’ blog, Ankita Rao reports on a new app for patients and physicians: "Last year Dr. Michael Nusbaum introduced a mobile application in an effort to make scheduling a medical appointment as easy as sending a Facebook message to a friend, and as safe as sharing your medical information in person at the doctor's office" (Rao, 2/27).

Also on Capsules, Jay Hancock reports on news from Tenet about hospital prices for exchange patients: "How much will hospitals reduce prices in an effort to win what are expected to be millions of newly insured patients under the Affordable Care Act? A little, not a lot, if deals disclosed this week by Tenet Healthcare are any indication" (Hancock, 2/28).Check out what else is on the blog.

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Political Cartoon: 'Ready For My Closeup?'

Kaiser Health News provides a fresh take on health policy developments with "Ready For My Closeup?" by Lisa Benson.

Meanwhile, here is today's health policy haiku:


My top health concerns:
Ryan Zimmerman's shoulder
and Strasburg's elbow. 

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Health Spending And Fiscal Battles

Does Sequestration Offer A Budgetary Bright Side?

News outlets set the scene for the impact on the health care sector and the Medicare program by the sequester's scheduled cuts, which kick in March 1.

The New York Times: Parties Focus On The Positive As Budget Cuts Draw Near
For weeks, President Obama has barnstormed the country, warning of the dire consequences of the cuts to military readiness, educators, air travel and first responders even as the White House acknowledges that some of the disruptions will take weeks to emerge. The reverse side has gone unmentioned: Some of the most liberal members of Congress see the cuts as a rare opportunity to whittle down Pentagon spending. The poor are already shielded from the worst of the cuts, and the process could take pressure off the Democratic Party, at least in the short run, to tamper with Social Security and Medicare (Weisman, 2/27).

The Associated Press/Washington Post: Senate Democrats And GOP To Stage Votes On Rival Plans To Address Automatic Budget Cuts
Democrats controlling the Senate are pushing a $110 billion plan that would block the cuts through the end of the year. They would carve 5 percent from domestic agencies and 8 percent from the Pentagon but would leave several major programs alone, including Social Security, Medicaid and food stamps, while limiting the cuts to Medicare to a 2 percent reduction to health care providers like doctors and hospitals. … Republicans were sure to kill the Democratic alternative with a filibuster. They were poised to offer an alternative of their own that would give Obama the authority to propose a rewrite to the 2013 budget to redistribute the cuts. Obama would be unable to cut defense by more than the $43 billion reduction that the Pentagon faces and would be unable to raise taxes to undo the cuts (2/28).

Los Angeles Times: 'Sequester' Cuts To Hit Healthcare Hard
As the Obama administration begins to implement $85 billion in cuts to federal spending this year, no part of the budget other than defense will take a bigger hit than healthcare. And the so-called sequester appears likely to have a disproportionate effect on areas of the health system already hobbled by years of retrenchment or underfunding, including public health and medical research (Levey, 2/27).

The Associated Press: No Ruckus About Medicare Cuts In Sequester
Hospitals, doctors and other Medicare providers are on the hook for a 2 percent cut under looming government spending reductions. But they're not raising a ruckus. Why? The pain could be a lot worse if President Barack Obama and congressional Republicans actually did reach a sweeping agreement to reduce federal deficits (Alonso-Zaldivar, 2/27).

Medscape: Medicare Pay To Shrink 2% As Sequester Looms On Friday
Unless a Congressional miracle occurs, Medicare reimbursement for physicians will decrease by 2% as $85 billion worth of automatic, across-the-board budget cuts called sequestration take effect on March 1 for the current fiscal year. Organized medicine is complaining not only about reduced pay, which could push struggling medical practices further into a hole, but also about the deleterious effect of even larger budget cuts in store for federal agencies such as the Centers for Disease Control and Prevention, the US Food and Drug Administration, and the National Institutes of Health (Lowes, 2/27).

CQ Healthbeat: Medicare Fraud Program Faces Sequester Cuts
The impending automatic sequester cuts could harm the progress made by programs battling Medicare fraud and abuse, administration officials said at a House subcommittee hearing. Although spending cuts on Medicare itself are limited to 2 percent under the sequester, programs at the Centers for Medicare and Medicaid Services are subject to larger reductions (Ethridge, 2/27).

Modern Healthcare: Sequester's Medicare Cuts Would Start With Services Provided In April
If sequestration kicks in Friday as planned, the 2% payment reduction to Medicare providers and insurers will be for services provided on or after April 1, an HHS spokesman confirmed Wednesday. When asked if HHS has already alerted providers and insurers about the date of the payment cuts, the spokesman replied in an e-mail, "If sequestration occurs, official notifications will be made." The lack of any notice from HHS left provider groups to wonder when their members will see those reductions. An official for the American Health Care Association—which represents skilled-nursing facilities and assisted-living providers—said there has been confusion among the organization's staff and lawyers about when those cuts would take place, while the American Hospital Association, Federation of American Hospitals and National Association of Public Hospitals and Health Systems all anticipated the cuts would begin in April (Daly and Zigmond, 2/27).

The Washington Post: Sequester Spin Gets Ahead Of Reality
State and local governments could also shift money around to blunt the impact on some popular programs such as Meals on Wheels, which delivers food to homebound elderly people and is funded with flexible federal grant money. And some of the scariest scenarios — say, concerns that the Centers for Disease Control and Prevention, which stands to lose more than $300 million, will not have the resources it needs to spot and contain the next deadly disease outbreak — are by their nature impossible to quantify. "The threats aren't decreasing," said CDC Director Tom Frieden. "I can't predict when an outbreak is going to happen" (Tumulty and Layton, 2/27).

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Health Reform

State Lawmakers' Positions On Medicaid Expansion Key To Plans' Future

Even after governors -- both Republican and Democrat -- express their interest in opting for the health law's Medicaid expansion, the action that follows in state legislatures is important to watch. News reports follow from states including California, North Carolina, Wisconsin, Nebraska and Virginia.

California Healthline: How Many States Are Really Opting Into ACA? Devil's In The Details
Same story, different week: A governor who opposed the Affordable Care Act changes course and announces plans to opt into the Medicaid expansion. Supporters of the ACA rejoice, conservatives grumble, and a new number gets tacked on the board -- 24 states opting in, at last count. Yet there's more to the story than governors' speeches. In at least eight of those states, lawmakers are warning that they may not go along with expansion plans. Those legislative logjams -- and what governors need to do to circumvent them -- vary state by state , but the fights are falling out along party lines (Diamond, 2/27).

Los Angeles Times: Key Senate Panel To Consider Medi-Cal Expansion
A key Senate panel will consider legislation Wednesday that would dramatically expand Medi-Cal, the state's public insurance program for the poor. The proposal, authored by state Sen. Ed Hernandez (D-West Covina) and Senate leader Darrell Steinberg (D-Sacramento), is part of a legislative package that aims to help California implement President Obama's healthcare overhaul (Mishak, 2/27).

California Healthline: Uncertain Assumptions In Health Care Budget Estimate, LAO Says
Two reports released yesterday by the Legislative Analyst's Office analyzing Gov. Jerry Brown's proposed health care budget for 2013-14 found a number of points of concern, according to Mark Newton, deputy legislative analyst at the LAO. … The report said the Legislature should make sure it eliminates or trims programs such as the Major Risk Medical Insurance Program for high-risk beneficiaries when the Affordable Care Act provisions and Medi-Cal expansion make those programs duplicative (Gorn, 2/28).

The Associated Press: Governor Uncorks Medicaid Expansion Plan
[Montana] Gov. Steve Bullock said Wednesday that federal money for Medicaid will create jobs in the state and help solve costs associated with uninsured patients, applying pressure to Republican legislative leaders to expand the program. Bullock unveiled his plan for Medicaid expansion Wednesday, a highly anticipated measure that aims to ensure that most of the state's residents have health insurance (Gouras, 2/27).

The Associated Press: Lawmakers Reject Medicaid Expansion
North Carolina lawmakers approved a bill Tuesday barring the state from expanding Medicaid under the federal health care overhaul. Gov. Pat McCrory, a Republican, has indicated he'll sign the GOP-backed bill when it reaches his desk. The measure approved by the House and Senate makes clear that North Carolina doesn’t want to expand Medicaid eligibility and will leave the operation of the state’s online health insurance marketplace to the federal government (Biesecker, 2/27).

The Associated Press: Erpenbach: I've Talked With Republicans On Medicaid Deal
Democratic state Sen. Jon Erpenbach said Tuesday that he and some of his Republican colleagues have discussed temporarily accepting a federally funded expansion of Medicaid against the wishes of Republican Gov. Scott Walker. Erpenbach talked about the possible deal during the Wisconsin HealthWatch conference, a meeting of policymakers, consumer advocates, and health care industry representatives. Erpenbach was on a panel of Democratic lawmakers, all of whom roundly criticized Walker’s recent moves to reject key portions of the federal health care overhaul law (Bauer, 2/27).

The Associated Press: Heineman Holds Firm In Opposition To Medicaid
Nebraska Gov. Dave Heineman held firm Wednesday in his opposition to a proposed Medicaid expansion, saying the state shouldn't rush into the program when the potential costs are unclear. The Republican governor said in an interview that he remains adamantly opposed to the expansion, even as a growing number of GOP governors have decided to back the proposal (Schulte, 2/27).

CQ Healthbeat: Virginia Health Secretary Says Medicaid Expansion Not A Done Deal
A Medicaid expansion in Virginia won't be a done deal until its existing program is overhauled, and there’s no timetable or deadline for a decision on expansion, the commonwealth’s secretary of health and human resources said in an interview Wednesday. The comments by William A. Hazel, appointed by Republican Gov. Bob McDonnell, came as attention has been focused on decisions by a series of Republican governors in other states who have clearly stated their support for expanding their health programs for the poor under the overhaul law (Norman, 2/27).

The Lund Report: Officials Hope To Curtail Rise Of Insurance Costs Under ACA
Concerns have been mounting by lawmakers and public officials that once the Affordable Care Act kicks in next January, those who purchase their own health insurance will face exorbitant prices. That was the conclusion reached by an independent consultant hired by the state of Oregon last July who analyzed the potential rate changes and its effect on people who would not qualify for a tax subsidy because they earn more than 350 percent of the federal poverty level. But now there’s hope on the horizon. For the past several weeks, legislative leaders, along with state officials and representatives from the business community (among them, Associated Oregon Industries and the Oregon Business Association), have been holding closed door meetings to come up with a way of mediating those cost increases, according to several high-ranking officials who spoke to The Lund Report (Lund-Muzikant, 2/27).

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Arkansas, Michigan Advance Payment Plans For Health Exchanges

Today's headlines include reports that Arkansas will use federal funds to pay for its state-based health exchange while action in Michigan suggests momentum might be building to pursue a partnership exchange that will be run by the federal government.

Politico: Arkansas To Use Federal Funds For Exchange
Arkansas Gov. Mike Beebe's office says the state has received approval from Health and Human Services to take federal Medicaid expansion money and use it to buy private coverage for low-income residents through the state's insurance exchange (Cheney and Millman, 2/28).

The Associated Press: Mich. Panel OKs $31M For Health Care Exchange
A Michigan legislative panel on Wednesday voted to spend the $31 million in federal grant money allocated for the creation of the state's online health insurance marketplace, a key component of the federal health care overhaul. The 24-3 vote by the House Appropriations Committee signals the Republican-led Legislature may be ready to back GOP Gov. Rick Snyder's plan to pursue a partnership controlled almost entirely by the federal government (Eggert, 2/27).

Meanwhile, in Georgia -

Georgia Health News: Health Exchanges: Will Some Be Left Out?
The state health insurance exchanges coming in January 2014 are expected to offer a good deal for many consumers — better coverage at a better price. That debut of exchanges, part of the Affordable Care Act, provides the rationale behind a House bill that would eliminate temporary "conversion" policies for people who have lost group health insurance coverage. The legislation would also end the current "assignment" policies that cover an estimated 2,000 Georgians with medical conditions. States can create their individual exchanges, but Georgia has opted to let the federal government create the one here. House Bill 389's supporters say the exchanges — which will prohibit insurance discrimination based on pre-existing conditions — will provide improved benefits at a price that's lower than conversion and assignment policies (Miller, 2/27).

In other exchange news -

Kaiser Health News: Capsules: Tenet Shows Hospitals Will Cut Prices For Exchange Patients
How much will hospitals reduce prices in an effort to win what are expected to be millions of newly insured patients under the Affordable Care Act? A little, not a lot, if deals disclosed this week by Tenet Healthcare are any indication (Hancock, 2/28).

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Health Law Implementation Pushes Quality Goals Forward

The Washington Post reports on hospitals' efforts to reduce readmission rates, while KHN details how some states are working on insurance coverage quality ratings before the federal health law requires them to do so in 2016.

The Washington Post: Health Law's Rules Help Hospitals Cut Patient Readmission Rate
Over the past several months, America's hospitals have achieved a feat that long seemed beyond reach: substantially reducing the share of patients who must return for treatment almost as soon as they are discharged (Aizenman, 2/27).

Kaiser Health News: Some States Will Rate Health Plans On Quality This Fall
This fall, health insurers in a few states will be seeing stars. Not the celestial kind, but stars that reflect their scores on quality measures designed to help consumers make better-informed decisions about what coverage to buy (Appleby, 2/28).

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Report: Medicare Paid $5.1B To Nursing Homes That Provided Substandard Care

The Associated Press/Washington Post: Fed Watchdog Report Says Medicare Paid $5.1B To Nursing Homes Offering Poor Care
Medicare paid billions in taxpayer dollars to nursing homes nationwide that were not meeting basic requirements to look after their residents, government investigators have found. The report, released Thursday by the Department of Health and Human Services' inspector general, said Medicare paid about $5.1 billion for patients to stay in skilled nursing facilities that failed to meet federal quality of care rules in 2009, in some cases resulting in dangerous and neglectful conditions (2/28).

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Capitol Hill Watch

Health Law, Medicare Benefit Design Draw Congressional Attention

House GOP doctors released a "health care state of the union" video that included health law criticisms, but no talk of repeal. Meanwhile, issues like Medicare copays and quality were discussed during a Ways and Means hearing earlier this week.

The Hill: GOP Doctors Slam 'ObamaCare' In 'Healthcare State Of The Union'
House Republican doctors released a "healthcare state of the union" video Wednesday that criticizes President Obama's signature healthcare law but does not mention repealing it. The video shows floor speeches from frequent critics of the healthcare law, including Reps. Phil Roe (R-Tenn.) and Phil Gingrey (R-Ga.). It shows lawmakers arguing that the Affordable Care Act will raise costs and criticizing its taxes on medical devices (Baker, 2/27).

Medpage Today: Link Medicare Copays, Quality, Congress Told
Medicare should be allowed to vary patient copays so that beneficiaries pay less for higher-quality, higher-value services, health reform experts told Congress Tuesday. Lawmakers should give Medicare the flexibility to charge patients more or less depending on the relative value of that service, experts told the House Ways and Means Health Subcommittee in a hearing examining Medicare's benefit design. For example, diabetic patients should have lower copayments on eye exams than nondiabetic patients. … On Wednesday, the Senate Special Committee on Aging will examine ways to reform Medicare's delivery models without reducing benefits. The Senate Finance Committee will hold a similar hearing on Thursday (Pittman, 2/27).

Kaiser Health News: FAQ On Medicare Doctor Pay: Why Is It So Hard To Fix?
While physicians have sidestepped drastic Medicare payment cuts for 2013, doctors' groups and lawmakers are gearing up for yet another battle to scrap the formula that forces Congress to consider the "doc fix" on a yearly basis. For doctors, the nail-biter has become a familiar but frustrating rite. Lawmakers invariably defer the cuts prescribed by a 1997 reimbursement formula, which everyone agrees is broken beyond repair. But the deferrals are always temporary due to the difficulty of finding offsetting cuts to pay for a permanent fix (Carey, updated 2/27).

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State Watch

States Take Up Mental Health Care, Stricter Gun Control As Shooting Fallout Continues

Fallout from recent mass killings involving the mentally ill have states scrambling to figure out how to best treat these patients as well as considering stricter gun controls -- which, in turn, is drawing the ire of the National Rifle Association.

Bloomberg: Expecting Mental Care To Curb Shootings Overlooks Neglect
Counting on improved mental-health care to help avert gun violence such as the shootings in Newtown, Connecticut, and Tucson, Arizona, overlooks years of neglect and funding cuts. The National Rifle Association and its mostly Republican allies propose bolstering the mental-health system in place of gun-control measures sought by President Barack Obama and other Democrats. States have reduced mental-health spending by 10 percent since 2009, and with federal spending cuts starting March 1, money for improvements is scarce (Rowley, 2/27).

CT Mirror: Mental Health Panel To Endorse Educator Training, Case Management, Not Outpatient Commitment
A bipartisan legislative panel crafting policy changes in response to the massacre at Sandy Hook Elementary School is expected to recommend that case management be available to people with serious mental illness and that educators receive "mental health first aid" training to recognize signs of problems. The committee will also recommend creating a task force to look at ways to improve the mental health system for adolescents and young adults, including addressing gaps in private insurance coverage. And it's likely to endorse a Massachusetts program that helps pediatricians intervene when children have psychiatric needs, the group's co-chairwomen said Wednesday (Becker, 2/27).

Health Policy Solutions (a Colo. news service): Massacres Revive Debate On Involuntary Commitment, Better Treatment
The subject of forced hospitalization of potentially dangerous mentally ill people -- known as involuntary commitment -- has gained currency in the immediate aftermath of the killings. Had a stricter involuntary commitment law been in place, some argue, suspected shooter James Holmes might have been in a psychiatric hospital rather than an Aurora movie theater on the night of July 20, 2012. But many experts believe involuntary commitment is a specious solution to a very complex and poorly understood problem. Involuntary commitment laws may very well need to be beefed up, say many, but such a move in itself is no guarantee we can prevent massacres like the ones in Aurora and Sandy Hook (Winter, 2/27).

NPR: For Bloomberg, Guns (Like Big Sodas) Are A Health Issue
The victory of a pro-gun-control candidate in the Illinois Democratic primary race to replace Rep. Jesse Jackson Jr. was also a political win for New York City Mayor Michael Bloomberg, whose superPAC backed the winner over a candidate it linked to the NRA. But Robin Kelly's victory Tuesday was, for Bloomberg, more than just another achievement on the gun control front. It was one more win in Bloomberg's unique assault on what he views as the public health problems of our time (James, 2/27).

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Sole Miss. Abortion Clinic Readies For License Revocation Hearing; N.Y. Gov.'s Abortion Bill Criticized

Mississippi health department officials are challenging the license of the state's only abortion clinic, while critics of a proposal to expand abortion rights by New York Gov. Andrew Cuomo say it would hurt women.

The Associated Press/Washington Post: Only Miss. Abortion Clinic Set For License Revocation Hearing; State Says Violating New Law
Mississippi's only abortion clinic says it is scheduled for an April 18 license revocation hearing before the state Department of Health. The Center for Reproductive Rights said Wednesday that the Jackson Women's Health Organization had received notice of the hearing date (2/27).

The Associated Press/Wall Street Journal: Critics: NY Gov's Abortion Bill Would Hurt Women
A coalition of doctors said Wednesday that Gov. Andrew Cuomo's abortion rights bill would hurt women, force many into lifetime bouts of depression and guilt and make late-term abortions more common and more dangerous. The group's press conference was the first effort outside the state Conservative Party, the Republican Party and the Catholic Conference to oppose Cuomo's proposed Women's Reproductive Health Act (2/27).

In the meantime, abortion-rights group NARAL is redefining "choice" to include access to fertility treatments and is endorsing longtime Rep. Edward Markey of Massachusetts in his bid for the Senate --

Politico: Long After Roe V. Wade, NARAL To Redefine Choice
The new head of NARAL Pro-Choice America is ready to redefine "choice." It's the right to end a pregnancy -- and the right to start one, including access to pricey fertility treatment. Once a baby is born, parents should have paid family leave to take care of them (Smith, 2/28).

Boston Globe: Markey Says Abortion Shift Was Personal
Since U.S. Representative Stephen F. Lynch of South Boston backed off his staunch opposition to abortion early this month, his rival for U.S. Senate has been trying to distinguish himself as the only Democrat in the race who is "100 percent pro-choice." U.S. Representative Edward J. Markey of Malden has made the case so well, in fact, that the abortion rights group NARAL Pro-Choice America plans to formally endorse him on Thursday. But three decades ago, Markey was also an abortion opponent who had a conversion before embarking on a campaign for higher office. His evolution began as a congressman, months before he ran for the same Senate seat he's seeking now (Ebbert, 2/28).

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State Roundup: Medicaid Costs Slow States' Recovery

A selection of health policy news from Kentucky, California, Minnesota, Virginia, Vermont and Kansas.

Stateline: States In Recovery: Revenues
Like a bad hangover that won't go away, some states are still suffering from the effects of the recession that technically ended three and half years ago. … Some states, including Iowa, Indiana and Tennessee, started the new session with surpluses, but none are planning to embark on new spending. States are saving much of their surpluses for anticipated cuts in federal funding, a critical revenue source for many states; increases in Medicaid costs; or to provide a cushion to cut income taxes. Overall, Medicaid is still the biggest budget worry for most states in the coming year. Medicaid spending continues to be the single largest component of total state spending at nearly 24 percent, easily surpassing K-12 education at less than 20 percent (Prah, 2/28).

The Associated Press: Panel Oks Second Bill To Resolve Medicaid Disputes
Two bills gained traction in the [Kentucky] Legislature Wednesday that would address millions of dollars in Medicaid disputes between hospitals and the organizations that provide reimbursements. Each proposal takes a different approach to an issue that hospitals say has compromised care for some of Kentucky's low-income residents. But one organization that provides Medicaid reimbursements to hospitals has concerns about the proposals' cost and workability (Finley, 2/27).

Los Angeles Times: Insurers Not Covering Behavioral Therapies For Autism, California Says
Insurers have been skirting their obligation under recently enacted state law to provide costly behavioral therapies for autism, according to the Department of Insurance, which is proposing emergency regulations aimed at enforcing the law. In July, California joined more than two dozen other states in requiring private insurers to cover such treatments when medically necessary (Zarembo, 2/28).

MPR News: Hundreds Stuck In Mental Health System, Says Legislative Auditor's Report
Hundreds of people in Minnesota with mental illness remain stuck in state-run psychiatric facilities for months or years after they are ready to leave, according to a report released today by the state Office of the Legislative Auditor. The failure to discharge patients or provide community housing options may violate patients' legal rights and likely puts the state at risk of lawsuits, the audit found. More than one-third of patients at the Anoka Metro Regional Treatment Center are ready to be discharged but remain hospitalized, in part because of a lack of community resources, according to the 136-page report (Baran, 2/27).

The Associated Press/Washington Post: Va. AG, Pharmaceutical Company Agree To $223,000 Settlement Over Unapproved Drug
Virginia's Medicaid program will receive more than $223,000 under a settlement that resolves allegations that a Texas-based company submitted false claims for an unapproved drug. Attorney General Ken Cuccinelli announced the settlement Wednesday (2/28).

The Associated Press: Vt. House Panel Oks Tax On Sugar-Sweetened Drinks
A state House committee reversed itself on Wednesday and approved a penny-an-ounce tax on sugar-sweetened beverages to pay for health care subsidies, but the idea appears still to have a bumpy road ahead. The House Health Care Committee had defeated the measure on a 5-5 tie vote on Friday. But on Wednesday, the panel voted in two 7-4 tallies to advance the measure after a motion to reconsider from Rep. George Till, who had set up Friday’s tie vote by unexpectedly leaving during committee deliberations (Gram, 2/28).

Kansas Health Institute: Committee Votes To Shelve Bill That Would Beef Up Nursing Home Staffing
A House committee today voted to shelve a bill meant to increase staffing levels in Kansas nursing homes. "There's no time," said Rep. Daniel Hawkins, a Republican from Wichita. "Everybody felt like we needed more time to think about this, so it's easiest just to table it and take it up next year." Hawkins, a member of the House Committee on Children and Seniors, opened the panel's hearing Wednesday with a motion to table House Bill 2348. The motion passed on a voice vote that was close to unanimous (Ranney, 2/27).

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Weekend Reading

Weekend Reading: Navigating Treatment; Can A Robot Replace Your Doctor?

Every week reporter Ankita Rao selects interesting reading from around the Web.

Health Affairs: An Accidental Tourist Finds Her Way In The Dangerous Land Of Serious Illness
Your pathology report indicates that you have stomach cancer. Hearing those words conveying yet another cancer-related diagnosis—my fourth since the age of 20—I felt, at the age of 57, as though I had been airdropped into a foreign country. Once again, I didn't know the language and didn't understand the culture. I had no road map and desperately wanted to find my way home.  Following my previous diagnoses (Hodgkin's disease in 1973, cervical in 1981, and colon in 2005), this new diagnosis came with new words to describe what had gone wrong in an unfamiliar organ system. There were new approaches to treatment that bore only a passing resemblance to those I had experienced before, and new specialists, subspecialists, tests, and procedures. I needed to master these terms, and quickly, as part of my latest effort to survive (Jessie Gruman, February 2013).

The Atlantic: The Robot Will See Your Now
IBM's Watson—the same machine that beat Ken Jennings at Jeopardy—is now churning through case histories at Memorial Sloan-Kettering, learning to make diagnoses and treatment recommendations. This is one in a series of developments suggesting that technology may be about to disrupt health care in the same way it has disrupted so many other industries. Are doctors necessary? Just how far might the automation of medicine go? (Jonathan Cohn, March 2013).

The Daily Beast: Can The Cleveland Clinic Save American Health Care
"The best doctors are not motivated by money." It's a common sentiment (this particular example comes from the comments section of Felix Salmon's blog, but you see it anywhere that doctor salaries are discussed.) … But what if we actually did take money out of the equation? What if we put doctors on salary and substituted relentless cost-control for "anything goes"? Well, say critics, probably you'd get what everyone complained about with HMOs: a situation where providers have every incentive to undertreat instead of overtreat. We didn't like that, either. And yet, there are places where it works. One of them is the Cleveland Clinic, one of the nation's leading hospital centers (Megan McArdle, 2/26).

Time: Remembering Dr. C. Everett Koop, America's Doctor
Koop, 96, passed away at his home in New Hampshire on Feb. 25. With his trademark beard and no-nonsense demeanor, Koop, who was a native of Brooklyn, New York, liked to play the part he was assigned, often appearing in public in the traditional vice admiral's uniform of the Public Health Service that came with the position of Surgeon General. ... Koop took a relatively obscure position in the government and over his seven-year tenure infused it with a responsibility and obligation to improve public health that his successors still strive to meet. "While he was Surgeon General, he was America's doctor," says Paul Billings, senior vice president for advocacy and education for the American Lung Association. "He recognized he was a highly visible spokesperson, and he was the personification of what the Surgeon General can and should be" (Alice Park, 2/27). 

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Editorials and Opinions

Viewpoints: Michelle Obama Makes A Business Case For Healthy Food; Orszag Weighs Reforms To Medical Malpractice

The Wall Street Journal: The Business Case For Healthier Food Options
For years, America's childhood obesity crisis was viewed as an insurmountable problem, one that was too complicated and too entrenched to ever really solve. According to the conventional wisdom, healthy food simply didn't sell—the demand wasn't there and higher profits were found elsewhere—so it just wasn't worth the investment. But thanks to businesses across the country, today we are proving the conventional wisdom wrong (Michelle Obama, 2/27). 

Politico: Under ACA, Employer Mandate Could Mean Fewer Jobs
With the employer mandate, Obamacare puts the nation’s job creators between a rock and a hard place. Despite the gentle sounding title, the Shared Responsibility provision actually takes the two parties who should be making decisions about employer-sponsored health coverage (the employer and the employee) completely out of the equation. Beginning in 2014, large employers must provide a prescribed level of health care coverage to all full-time employees or potentially pay a hefty penalty. While this may sound relatively straightforward, it is anything but (Dan Danner, Bruce Josten, Matthew Shay and Dirk Von Dongen, 2/27).

Bloomberg: To Fix U.S. Budget, Reform Medical Malpractice Law
The sequestration that is about to take effect imposes too much austerity too soon, does so in a nonsensical way, and yet does little to improve the long-term U.S. fiscal picture. Far more beneficial would be to make sure that the deceleration in health costs we have been enjoying continues. This is why medical-malpractice reform, although far from a panacea, is worth trying (Peter Orszag, 2/27).

The Wall Street Journal's Political Diary: The Jersey Doughboy
Chris Christie just can't help himself, can he? Whenever the feds are offering dough—and it's free—he's got to have some. The New Jersey governor yesterday embraced the ObamaCare Medicaid expansion on the grounds that if New Jersey doesn't help itself to the Medicaid pie, other states would just take its share (Allysia Finley, 2/27).

JAMA: State Health Exchanges, A Skeptical Public, And The Role Of Health Care Professionals
Although there is concern that some insurance companies may decide it's too unprofitable for them to participate in the exchanges, the most pressing challenge for most of the exchanges will be meeting their enrollment goals. And that's where health care professionals come in. Primary care practices, community health centers, and emergency rooms provide crucial opportunities for uninsured patients to learn about getting covered at a low cost—and, in some cases, for free. As trusted sources, physicians and nurses—and all health care professionals—hold the keys to raising awareness about the exchanges (Diana Mason, 2/27).

Medpage Today: Zero Tolerance For Medical Error? Think Again!
After only a couple of incidents, the federal government grounded this newest, most technically sophisticated (Boeing 787 "Dreamliner") airliner until the problem was fully understood, the deficiency corrected, and the risk to passengers and crew minimized. Shouldn't we address surgical "never events", which affect 4,160 patients each year, with the same urgency and gravity that we address the potential risk to 210-270 passengers of travelling in the "Dreamliner"? (Dr. David Nash, 2/27).

Oregonian: Boost Oregon's Childhood Vaccination Rates By Trying Washington's Technique
Oregon could wait for an epidemic. The state could retain its casual approach to childhood vaccinations and keep its ranking as the nation's worst for protecting children against terrible and preventable diseases. Or, Oregon could follow Washington's lead and take one simple step to improve its childhood vaccination rates -- and do so without infringing on anyone's religious liberty. The choice is clear. Oregon should pass a Senate bill under consideration that would require parents who withhold mandatory vaccines from their children to get a doctor's signature showing that they have been informed of the risks and benefits (2/27).

Los Angeles Times: Critiquing The Stem Cell Board
After years of resisting all criticisms of its operations, the California Institute for Regenerative Medicine is finally listening — a little. It spent $700,000 for an outside, high-level review that complimented the stem cell agency for funding an excellent portfolio of research projects, but also raised serious objections to the agency's structure, which the review said was likely to lead to financial conflicts of interest (2/27).

And The New England Journal of Medicine hosted several columns on the issue of open access in scientific journals.

The New England Journal of Medicine: Protecting Patient Privacy And Data Security
Too often, unauthorized people succeed in extracting protected information from health care providers. Invasion of privacy also affects noncelebrities, when anyone seeks health information the patient has not chosen to share. More often, though, scam artists seek patients' billing information for financial gain. The patient's insurance identifier is then used by an uninsured person to obtain medical services or by a fraudulent health care provider to bill for medical services that were never rendered. Data security breaches and medical identity theft are growing concerns, with thousands of cases reported each year. The Centers for Medicare and Medicaid Services (CMS) tracks nearly 300,000 compromised Medicare-beneficiary numbers (Dr. Julie K. Taitsman, Christi Macrina Grimm and Dr. Shantanu Agrawal, 2/27).

The New England Journal of Medicine: For the Sake Of Inquiry And Knowledge — The Inevitability Of Open Access
It's difficult to have a measured conversation about open access — the term widely used to refer to unrestricted online access to articles published in scholarly journals. People who believe that free and unrestricted access to peer-reviewed journal articles will undermine the viability of scholarly journal publishing disagree sharply with those who believe that only open access can expedite research advances and ensure the availability of that same scholarly literature. Arguments for and against open access tend to focus on implementation details, ignoring the powerful motivations underlying the phenomenon. ... There is no doubt that the public interests vested in funding agencies, universities, libraries, and authors, together with the power and reach of the Internet, have created a compelling and necessary momentum for open access. It won't be easy, and it won't be inexpensive, but it is only a matter of time (Ann J. Wolpert, 2/27).

The New England Journal of Medicine: Open But Not Free — Publishing In The 21st Century
Open-access publishing has gained traction over the past 10 years because of the success of the PLOS and BioMed Central families of journals. The annual volume of articles published in open-access journals has increased from 20,702 in 2000 to 340,130 in 2011 — accounting for 17% of all articles published in 2011.4 These articles were published in 6713 journals with full and immediate open access; 49% of them were published in journals requiring an author fee. The growth in open-access publishing has encouraged professional societies, commercial publishers, and even funders to launch new open-access journals. There is, however, a cost associated with this openness — a cost that may reduce the funds available for research. PubMed Central diverts approximately $4 million from the NIH budget in order to collect, process, and convert NIH-funded manuscripts into PubMed Central's archival format (Martin Frank, 2/27).

The New England Journal of Medicine: The Downside Of Open-Access Publishing
Most of the new open-access journals state that they are international, scientific, or scholarly peer-reviewed journals and offer quick turnaround times. ... Of course, the terms "international," "scientific," "peer-reviewed," "journal," "article," "editor," and "publisher" do not have copyrighted or patented definitions and can have varied meanings, especially in the Internet age. Must an article be different from a submitted paper? Isn't everything published online automatically international? Is there anything wrong with a situation in which the editor and publisher are just one person who has set up a website where researchers can submit their papers and pay a fee to have them laid out in a professional way and made available to all interested parties? Isn't it a good thing that this vast number of new publishers and journals will make it possible to get all research — whatever its quality level — into the public domain? Perhaps. But describing a simple online-posting service as "an international, scientific, peer-reviewed journal" leads authors and readers to believe that they are submitting to or reading something they aren't (Dr. Charlotte Haug, 2/27).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.